Illegal Substance Dependence Screening and Treatment for Recipients of City Public Assistance
Shall the City require single adults age 65 and under with no dependent children who receive City public assistance benefits and whom the City reasonably suspects are dependent on illegal drugs to participate in screening, evaluation and treatment for drug dependency for those adults to be eligible for most of those benefits?
Digest by the Ballot Simplification Committee
The Way It Is Now:
State law requires every county to provide public assistance programs for poor, single adults age 65 and under. San Francisco does so through the County Adult Assistance Programs (CAAP). Generally, CAAP serves only single adults age 65 and under with no dependent children. CAAP recipients collect benefit packages that pay for or provide needed services such as employment assistance, housing, shelter, utilities and food. In 2023, housed CAAP recipients generally received $712 per month. CAAP recipients experiencing homelessness received access to shelter and food through the City’s shelter system and a cash grant of up to $109 per month. CAAP recipients are entitled to full benefits regardless of whether they are dependent on illegal drugs.
The Proposal:
Proposition F would require anyone who receives CAAP benefits to be screened for substance use disorder if the City reasonably suspects the person to be dependent on illegal drugs. When screening indicates a recipient may be dependent on illegal drugs, the City will provide a professional evaluation and may refer the recipient to an appropriate treatment program. If that program is available at no cost, the recipient will be required to participate to continue receiving CAAP benefits. The measure does not require recipients to maintain sobriety to be eligible for benefits.
Under Proposition F CAAP recipients who stop receiving benefits because they refuse to participate in a required screening, evaluation or treatment would continue to receive housing assistance for at least 30 days. The City may extend their housing benefits beyond 30 days if necessary to avoid eviction.
Proposition F would create a City fund to support the costs of screening, evaluation and treatment. Any cost savings from discontinuing public assistance would go into that fund.
A "YES" Vote Means: If you vote "yes," you want to require single adults age 65 and under with no dependent children who receive City public assistance benefits and are reasonably suspected to be dependent on illegal drugs to participate in screening, evaluation and treatment to be eligible for most of those benefits.
A "NO" Vote Means: If you vote "no," you do not want to adopt this requirement.
Controller's Statement on "F"
City Controller Ben Rosenfield has issued the following statement on the fiscal impact of Proposition F:
Should the proposed initiative ordinance be approved by the voters, in my opinion, it would have a moderate impact on the cost of government. Administration of the proposed program, including screening and assessing aid recipients, is estimated to cost between $500,000 and $1.4 million annually. These costs would be offset by estimated annual savings of between $100,000 and $2 million from recipients who are no longer eligible to receive aid, with any additional savings available for treatment and other services for other program recipients. The total cost of this ordinance would be dependent on operational decisions made by the Human Services Agency (HSA) and decisions made by the Mayor and the Board of Supervisors through the normal budget process.
The proposed initiative ordinance would amend the Administrative Code, establishing screening and treatment requirements for County Adult Assistance Program (CAAP) recipients with drug-related substance use disorders. In Fiscal Year 2022-2023, there were approximately 5,700 monthly CAAP recipients in San Francisco. If the ordinance is approved, CAAP recipients who decline drug screening, evaluation, and treatment will be considered non-compliant and be ineligible for CAAP benefits. Discontinued CAAP recipients would be provided 30 days of housing support through either rental subsidies paid directly to the landlord or guaranteed shelter access, with potential extensions for eviction prevention. Housing support would be paid for by diverting the recipient’s previous cash grant for housed recipients or provided through the City’s existing shelter capacity already designated for unhoused CAAP recipients.
If the proposed ordinance is approved, the cost to administer CAAP may increase due to new drug screening, assessment, and case management needs for recipients who screen positive for illegal drug use. Case management costs may be reimbursed under Drug Medi-Cal. Increased costs will be dependent on operational decisions made by HSA and budget decisions made by the Mayor and the Board of Supervisors through the normal budget process.
CAAP cost savings from discontinued recipients would be diverted into a CAAP Treatment Fund (Fund), potentially offsetting some costs of screening, assessments, and treatment. Currently, CAAP recipients experiencing homelessness receive $109 per month, with in-kind support provided at City shelters, and housed CAAP clients receive $712 per month. Cost savings diverted from discontinued recipients would be diverted to the Fund. It is unknown exactly how many clients would be discontinued under the proposed ordinance, savings could range from approximately $200,000 to $4 million in the first year to approximately $100,000 to $2 million in subsequent years.
If this ordinance is approved, it may result in increased costs if existing treatment capacity is not sufficient to meet the increased needs under this ordinance. While not required by the ordinance, if the City cannot meet the demand for services with existing or planned capacity, it may result in future costs subject to future budget decisions made by the Mayor and the Board of Supervisors through the normal budget process. Services that likely have capacity to serve newly referred CAAP clients include medication treatment, outpatient substance use disorder treatment, and mutual support groups. Additional capacity may be needed for residential treatment, withdrawal management, or residential step-down treatment programs. Total costs for treatment will depend on the number of CAAP clients who participate in treatment and in which program they participate. For context, for residential treatment programs, the treatment cost for a 90-day stay ranges from approximately $28,000 to $40,000 per person with reimbursement rates ranging from approximately $16,000 to approximately $28,000.
How "F" Got on the Ballot
On November 20, 2023, the Department of Elections received a proposed ordinance signed by Mayor Breed.
The Municipal Elections Code allows the Mayor to place an ordinance on the ballot in this manner.
This measure requires 50%+1 affirmative votes to pass.
Arguments are the opinions of the authors and have not been checked for accuracy by any official agency. Arguments are printed as submitted. Spelling and grammatical errors have not been corrected.
Proponent’s Argument in Favor of Proposition F
VOTE YES ON PROP F FOR TREATMENT + ACCOUNTABILITY
Prop F, the Treatment + Accountability Measure, adds another tool to San Francisco’s efforts to address the deadly drug use that is creating serious public safety hazards and fueling an overdose crisis on our streets.
Two people a day are dying of overdoses from Fentanyl and other deadly drugs in San Francisco. These are sons and daughters, mothers and fathers, brothers and sisters. Offers of treatment without accountability are not enough. We must do more to get people into treatment and save lives.
But under current state law, San Francisco lacks tools to compel people into treatment. The City deploys street teams to offer voluntary services and connections to treatment. While some people do accept help, many do not, being unwilling or unable to do so.
Prop F would allow the City to require single adults with substance abuse to participate in treatment in order to continue receiving cash assistance from the City and County of San Francisco.
Applicants will be offered substance use treatment if they are deemed to have a substance abuse condition. These treatment programs include a range of interventions, such as: residential treatment, medical detox, medically assisted treatment, outpatient options, and abstinence-based treatment, depending on the needs of the client.
Right now, San Francisco serves over 4,000 people with medication assisted treatment through medications like buprenorphine and methadone. Today, San Francisco can sign people up the same day they apply to one of these programs.
Prop F strikes the right balance between compassion and accountability, to ensure that substance abuse treatment is accepted more often than it is declined.
Vote YES on Prop F for compassion and accountability.
Mayor London Breed
Rebuttal to Proponent’s Argument in Favor of Proposition F
No rebuttal to proponent's argument in favor of proposition submitted.
Opponent's Argument Against Proposition F
Prop F will increase the number of people experiencing homelessness in San Francisco by taking away the basic services and support systems that keep those in greatest need off the streets.
Beyond more homelessness, Prop F will not solve problems with crime by making vulnerable people even more destitute.
San Francisco's government already cannot meet the current demands of the overdose crisis. Experts agree we simply do not have enough treatment capacity and supportive housing available for those who want care and need treatment.
Prop F defies accepted best practices for treating substance use disorder and addressing homelessness, and will have deadly results. Research by public health experts shows indisputable evidence that proposals such as Prop F lead to increased rates of return to substance use, overdose deaths, and suicide.
This initiative will take away vital assistance and employment services from low-income San Franciscans. San Francisco city government must prioritize getting people experiencing substance use disorder into stable and safe housing, and supportive services that serve as a pathway to treatment; not search for new ways to deny them basic support and sustenance and force them into the streets where they will grow the ranks of the homeless population.
San Francisco city leaders have failed to fulfill their promises to expand our public health system's capacity to address drug use and homelessness by not following through on their own 2022 Overdose Prevention Plan.
Don't let City Hall off the hook.
Vote NO on Prop F and join us at www.ReduceSFHomelessness.org.
Roma Guy, MSW and Former Public Health Commissioner*
Diane Jones, Registered Nurse*
*For identification purposes only; author is signing as an individual and not on behalf of an organization.
Rebuttal to Opponent’s Argument Against Proposition F
2023 is San Francisco’s deadliest year for drug overdoses. In the United States, 2022 was the deadliest overdose year on record. Fentanyl is a national crisis that demands new strategies.
Prop F ensures the City isn’t subsidizing addiction and making the crisis worse.
Prop F balances compassion and accountability to prevent overdoses and deaths, and gets people suffering from addiction into treatment.
Prop F has built-in eviction prevention and rental subsidies, to ensure anyone who temporarily loses cash assistance still has a roof over their head.
Prop F has built-in guardrails that ensure NO ONE loses cash assistance if the City doesn’t have treatment options available.
Prop F does not mandate sobriety. It asks individuals for good-faith efforts to seek treatment, in exchange for City-funded cash assistance.
Prop F ensures individuals are paired with the right treatment option, instead of mandating a one-size-fits-all treatment plan for everyone.
San Francisco Department of Public Health serves 25,000 people annually with mental health and addiction care, including over 4,000 people with medication-assisted treatment like buprenorphine and methadone. Right now, people can start treatment as soon as they apply to one of these medication programs.
Prop F is another tool the City can use to address the substance abuse that is ruining lives and fueling poor street conditions. It will create more accountability and help San Francisco make progress fixing the drug crisis.
Without Prop F, people will keep dying in record numbers on San Francisco’s streets. The status quo is unacceptable.
Vote Yes on F to save lives.
Supervisor Matt Dorsey
Supervisor Rafael Mandelman
Supervisor Catherine Stefani
Paid Arguments in Favor of Proposition F
1
Paid Argument IN FAVOR of Proposition F
We are addicts in recovery who support Proposition F.
Two people a day in San Francisco are dying of overdoses from Fentanyl and other deadly drugs. More people have died from drug overdoses in our city than COVID. This is a crisis we have been unable to address in a significant way.
Right now under state law, San Francisco lacks tools to compel people into drug treatment. While the City street teams offer voluntary services and connections to treatment, many people do not accept being unwilling or unable to do so.
Prop F would allow the City to require single adults with substance abuse to participate in treatment in order to continue receiving cash assistance from the City and County of San Francisco. Proposition F adds another tool to San Francisco’s efforts to address the deadly drug use that is creating serious public safety hazards and fueling an overdose crisis on our streets.
Offers of treatment without accountability are not enough. We must pass Proposition F to get more people into treatment. These are sons and daughters, mothers and fathers, brothers and sisters, we have to try everything in our power to save lives.
Supervisor Matt Dorsey
Positive Directions Equals Change
Sister's Circle Women's Support Network
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountable.
The sole contributor to the true source recipient committee: Chris Larsen.
2
Paid Argument IN FAVOR of Proposition F
SMALL BUSINESSES SUPPORT PROP F
San Francisco’s small businesses are the economic engine that power our city and that help make our city’s neighborhoods full of character and vibrancy.
But too many of our businesses are suffering from the impact of the drug crisis fueled by the most powerful drugs we have ever seen or experienced. This crisis has resulted in break ins by those looking to fund their drug addiction, and dangerous drug fueled behavior outside our businesses scaring employees and customers.
We are supporting Proposition F because it’s an essential tool the City currently lacks to be able to compel people into treatment for drug use. The City deploys street teams to offer voluntary services and connections to treatment, but most people don't accept help, being unwilling or unable to do so.
Proposition F would allow the City to require single adults with substance abuse to participate in treatment in order to continue receiving cash assistance from the City and County of San Francisco.
Proposition F is the type of strong, compassionate, and effective action we need to help address our drug crisis with treatment and accountability.
Ben Bleiman, SF Bar Owners Alliance
San Francisco Council of District Merchants Associations
Golden Gate Restaurant Association
Eva Lee, Chair, Chinatown Merchants Association*
*For identification purposes only; author is signing as an individual and not on behalf of an organization.
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
3
Paid Argument IN FAVOR of Proposition F
LOCAL ELECTED OFFICIALS SUPPORT PROP F
San Francisco is a world-class city, known for its beautiful skyline, amazing restaurants, one-of-a-kind culture, and tolerance. But one thing we cannot continue to tolerate is the drug crisis happening on our streets. People are dying everyday as a result of fentanyl.
That’s why it’s important we all support Prop F and take the next step in addressing the fentanyl crisis.
Prop F will give the City the power to mandate substance treatment for people receiving cash benefits. Now, let’s be clear. This isn’t mandating sobriety. It’s important to recognize that getting clean takes time and each person is unique when it comes to receiving treatment.
That’s why, Prop F and the City will ensure that many different types of treatment are available for individuals. This will not be a one-size-fits-all solution for users.
Prop F also has guard rails so if there aren’t enough treatment slots available, people won’t lose their cash assistance. Prop F also has a provision that will ensure people have 30-day eviction prevention and rental subsidies, so people won’t lose the roof over their head.
That’s why Prop F gets our support and why you should support it too.
Vote YES on Prop F.
Assessor Joaquín Torres
Supervisor Matt Dorsey
Supervisor Rafael Mandelman
Supervisor Catherine Stefani
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
4
Paid Argument IN FAVOR of Proposition F
AAPI COMMUNITY SUPPORTS PROP F
San Francisco is expected to have a record 800 fatal drug overdoses by the end of 2023, with most of those overdoses caused by Fentanyl.
We have to take action NOW to ensure more people get into treatment, to save their life. Continuing to allow people to die on our streets is not compassionate.
Proposition F would allow the City to require single adults with substance abuse to participate in treatment in order to continue receiving cash assistance from the City and County of San Francisco. It’s past time we take this next step to require people to participate in some treatment program. They have to try.
Proposition F also sends a strong message that San Francisco is closed to those who want to come to our city to freely do drugs on our streets. The door is shut!
Vanita Louie, AAPI Leader
Cyn Wang, Entertainment Commissioner*
Lily Ho, DCCC Candidate
Marjan Philhour, DCCC Candidate
Brian Quan, DCCC Candidate
Jade Tu, DCCC Candidate
Steven Lee, AAPI Leader
Eva Lee, Chair, Chinatown Merchants Association*
Forrest Liu, Stop Asian Hate Activist
Filipino American Democratic Club
Stand With Asians
Stand with Asian Americans
*For identification purposes only; author is signing as an individual and not on behalf of an organization.
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
5
Paid Argument IN FAVOR of Proposition F
PROP F CAN SAVE LIVES
The African American community is disproportionately affected by the overdose crisis compared to other racial or ethnic groups in San Francisco.
Too many people are dying each day from drug overdoses – sons, daughters, brothers and sisters. Proposition F is that extra incentive that will help compel people into drug treatment that can save their life.
We are a compassionate city that offers treatment on demand for those struggling with substance use. But many who are suffering need extra incentive to engage those treatment options and help them on a path to recovery.
The status quo is not working. Together, we can help save lives by voting Yes on Proposition F.
Mayor London Breed
Cedric Akbar, Director, Positive Directions Equals Change
Reverend Amos Brown
David Miles, Church of 8 Wheels
Meaghan Mitchell
Bayard Rustin Coalition
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
6
Paid Argument IN FAVOR of Proposition F
Democrats for Change support Prop F to ensure Treatment and Accountability
As candidates on the SF Democrats for Change slate, running for the San Francisco Democratic Central County Committee, we support Proposition F.
Too many people suffer in the vise of drug addiction, and more people in San Francisco have died from drug overdoses than died from COVID since the start of the pandemic.
Yet our city doesn’t have the ability to compel people into treatment and potentially save their life.
Proposition F is the right balance between compassion and accountability, to ensure that substance abuse treatment is accepted by people more often than it is declined.
Right now San Francisco treats 4,000 people with medication assisted treatment through medications like buprenorphine and methadone. There is treatment available the same day someone wants to access that treatment. Let’s help people into treatment by voting Yes on Proposition F.
Assembly District 19
Marjan Philhour
Michela Alioto-Pier
Sara Barz
Lanier Coles
Parag Gupta
Brian Quan
Catherine Stefani
Jade Tu
Assembly District 17
Cedric Akbar
Carrie Elise Barnes
Matt Dorsey
Emma Heiken
Lily Ho
Michael Lai
Laurence Lem Lee
Peter Lee
Nancy Tung
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
7
Paid Argument IN FAVOR of Proposition F
GROWSF SUPPORTS PROP F
Proposition F is a common sense measure that will help people get off drugs, into treatment, and back on their feet.
According to the September 2023 GrowSF Pulse poll, 74% of San Franciscans believe that people who are homeless and addicted to drugs should be required to enter substance abuse treatment in order to obtain housing and other services. We agree with regular San Franciscans.
Prop F doesn't require total sobriety to get assistance. Instead, Prop F only requires that drug addicts participate in a drug treatment program. Prop F will save lives by helping people access the treatment they need instead of a taxpayer-funded addiction. Recovery is possible, and we should help people get there.
GrowSF
The true source(s) of funds for the printing fee of this argument: Coalition for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
8
Paid Argument IN FAVOR of Proposition F
San Francisco today is Disneyland for drug tourists, but with free admission, food, and lodging. Society has a responsibility to help the least fortunate become healthy and self-sufficient. It doesn't have a responsibility to subsidize addiction and self-harm. This measure is a step in the right direction.
The Briones Society
Jay Donde
Bill Jackson
Tom Rapkoch
David Cuadro
Jennie Feldman
Christian Foster
Martha Ehmann Conte
Chris Lewis
Jan Diamond
Jennifer Yan
Peter Elden
Jamie Wong
Page Chamberlain
Bill Shireman
Grazia Monares
Josh Wolff
Nick Berg
Deah Williams
Jason Clark
Jeremiah Boehner
The true source(s) of funds for the printing fee of this argument: The Briones Society.
9
Paid Argument IN FAVOR of Proposition F
Vote Yes on Proposition F to improve street conditions and save lives.
Too many people with substance use disorders are deteriorating on our streets. Too many are dying every day, despite offers of treatment many don’t accept. It impacts our entire community, especially families.
Proposition F is a critical step we can take to incentivize those with substance use disorders to participate in a treatment program by requiring single adults with substance use disorder to participate in treatment in order to continue receiving cash assistance from the City and County of San Francisco.
San Francisco serves over 4,000 people with medication-assisted treatment through medications like buprenorphine and methadone. People can access immediate treatment the same day they apply to one of these programs.
It’s simply no longer okay to allow those who are a danger to themselves and others to refuse treatment without any accountability. Proposition F is part of a multi-pronged approach to address the Fentanyl crisis, and strikes the right balance between compassion and accountability.
Join us in voting Yes on Proposition F to improve street conditions and save lives.
Westside Family Democratic Club
The true source(s) of funds for the printing fee of this argument: Yes on F, for Treatment, Compassion and Accountability.
The sole contributor to the true source recipient committee: Chris Larsen.
End of Paid Arguments IN FAVOR of Proposition F
Paid Arguments Against Proposition F
1
Paid Argument AGAINST Proposition F
Prop F will increase homelessness and discourage people from seeking treatment.
Unhoused welfare recipients get a very paltry amount of cash equal to a little over $5 a day. For housed folks, they get a few hundred bucks to cover shelter, food and everything else. But they have to work for it unless they have a documented disability. There is one exception - they get their work requirement waived if they enter treatment.
This measure would instead discourage people from seeking treatment who need it, because they would be at risk of losing their housing, shelter and income.
Vote No on F
Coalition on Homelessness, San Francisco
The true source(s) of funds for the printing fee of this argument: Coalition on Homelessness.
2
Paid Argument AGAINST Proposition F
HEALTH AND HUMAN SERVICE NONPROFITS OPPOSE PROP F!
Prop F will take away basic benefits from people struggling with homelessness, disabilities and behavioral health issues, forcing them into a treatment system already facing a shortage of beds. By taking away support, this measure will increase homelessness and poverty. We need to address substance use disorders with evidence-based public health strategies, not punitive measures with unknown consequences and costs.
San Francisco Human Services Network
The true source(s) of funds for the printing fee of this argument: San Francisco Human Services Network.
Legal Text
Ordinance amending the Administrative Code to require recipients of aid under the County Adult Assistance Program (CAAP) who are reasonably believed to be dependent on illegal drugs to be screened for substance abuse, and to participate in appropriate substance abuse treatment where recommended by a professional evaluator; providing that failure to comply with the drug screening, evaluation, and treatment requirements without good cause will render a recipient ineligible for assistance under the CAAP program; allowing CAAP recipients who become ineligible for assistance due to non-compliance with the screening, evaluation, or treatment requirements to receive a housing stipend or access to in-kind shelter for 30 days beyond the discontinuance of their aid, with possible extensions as necessary to prevent eviction; and establishing a special fund to support the costs of the substance abuse screening and treatment program, using savings realized from implementation of the program.
NOTE: Unchanged Code text and uncodified text are in plain font.
Additions to Codes are in single-underline italics font.
Deletions to Codes are in strikethrough italics font.
Asterisks (* * * *) indicate the omission of unchanged Code
subsections or parts of tables.
Be it ordained by the People of the City and County of San Francisco:
Section 1. Findings and Statement of Purpose.
(a) New, synthetic opioids like Fentanyl have hit San Francisco – like cities across this country – hard. The current drug epidemic is unlike anything the City has seen before. In recent years, thousands of people overdose each year, and hundreds of those who overdose die. In 2022, the Fentanyl crisis took more than 700 lives in San Francisco, and as of October 2023 it was on track to take an even higher number of lives in 2023. The severity of this crisis calls for more tools to incentivize people into treatment, rather than blindly following the status quo.
(b) San Francisco must explore every avenue to address this overdose epidemic, including maximizing and streamlining access to care, providing shelter and housing to those in need, and disrupting the drug markets that fuel the epidemic. But the City will not save lives or improve street conditions if the substance use treatment that is offered is more often declined than accepted. More must be done to reduce the number of drug-related deaths occurring on our sidewalks and elsewhere in the City every single day. The failed policies of simply offering services to people who need treatment are not working.
(c) San Francisco offers and has available to anyone who chooses to access it, a myriad of service options. And the City is constantly working to add more services. Service options include:
(1) San Francisco has made significant investments in voluntary treatment options, adding 350 behavioral health beds in the past few years to the 2,200 health beds that already existed. And there are 50 more beds that will be added in the near future. In the last five or six years, San Francisco has nearly doubled its investment in its county behavioral health system and its substance use disorder treatment system of care.
(2) The San Francisco Department of Public Health at any one time serves approximately 25,000 people with mental health and addiction issues, through residential and outpatient services. In addition, street outreach teams connect people to all of the City’s programs.
(3) The City serves at any one time more than 4,000 people with Medication Assisted Treatment (MAT) by dispensing medications like buprenorphine and methadone. Right now, people who need treatment can access MAT the same day they seek services from one of the City’s MAT programs.
(4) The City has mobile pharmacies that go to shelters and permanent supportive housing. In addition, The City employs workers to deliver medications directly to people who are unhoused, so they can receive treatment and support no matter where they are within the City’s boundaries.
(5) San Francisco has outpatient services at 14 medical clinics across the City, where people can get access to treatment. This includes clinics like Maria X, which opened in early 2023 with a focus on serving the South of Market Area.
Yet even with this large investment of public funds to provide resources and help to those in need, the drug overdose epidemic continues.
(d) This ordinance is intended to help address the overdose epidemic by requiring individuals who receive assistance through the City’s County Adult Assistance Program (CAAP), and who have been professionally evaluated and determined to need treatment, to participate in drug abuse treatment programs. These treatment programs include numerous interventions ranging from residential treatment, medical detox, and Medication Assisted Treatment to outpatient options. There is no one answer. Although reasonable participation in treatment programs will be required, sobriety of participants will not be. What matters is that people get into treatment and try to improve their lives. Perfection isn’t the goal; improved health and life outcomes is.
(e) State law requires all counties in California to fund and administer programs that provide aid and support to indigent single adults. In San Francisco, this state requirement is met through the CAAP program, which is administered by the City’s Human Services Agency. In revising CAAP program eligibility and program requirements, this ordinance does not impact the benefit eligibility of individuals other than single adults. Benefit eligibility for seniors and families is unchanged.
(f) The goals of the CAAP program are to provide short-term financial or in-kind assistance and other services to City residents who are unable to support themselves; enable and encourage participants to find employment, if employable; and reduce or eliminate the conditions that have led to indigency and dependency. CAAP participants receive benefit packages that are intended to pay for or provide in-kind access to housing/shelter, utilities, food, and other costs. As of 2023, CAAP participants who were housed received $712 per month. CAAP participants who were experiencing homelessness and who did not pay rent received access to in-kind shelter and food through the City’s shelter system, as well as a cash grant of up to $109 per month.
(g) State law expressly authorizes counties to require adult recipients of general assistance benefits to undergo screening for substance abuse when it is determined by the county that there is reasonable suspicion to believe that an individual is dependent upon illegal drugs. State law further authorizes counties to require as a condition of aid reasonable participation in substance abuse treatment programs for persons who are professionally evaluated to need treatment, if the services are actually available at no charge to the applicant or recipient.
(h) In amending the eligibility and program requirements to include substance abuse screening and treatment for individuals with an identified drug use dependency, it is the primary goal of the City to help individuals address their substance use and to live healthier and more productive lives. By conditioning the receipt of cash assistance on compliance with drug screening and treatment requirements, this ordinance will create an incentive for CAAP participants who have a substance use disorder to engage in treatment and achieve self-sufficiency.
Section 2. Article VII of Chapter 20 of the Administrative Code is hereby amended by adding Section 20.7-26.5, to read as follows:
SEC. 20.7-26.5. SUBSTANCE ABUSE SCREENING, EVALUATION, AND TREATMENT.
(a) Screening. The Department shall require all adult Recipients of aid under the General Assistance, PAES, CALM, or SSIP Program to undergo screening for substance abuse when it is determined by the Department that there is reasonable suspicion to believe that an individual is dependent upon illegal drugs. The Department shall document all findings of reasonable suspicion.
(b) Professional Evaluation. Where the screening process set forth in subsection (a) indicates that there is reason to believe that a Recipient is abusing or dependent on illegal drugs, such Recipient shall undergo a professional evaluation for substance abuse. The professional evaluation may be performed by the Department, the Department of Public Health, or by an entity funded by the City to perform this function, subject to the Charter’s restrictions regarding contracting for personal services.
(c) Treatment. Recipients who are professionally evaluated and determined to need treatment for substance abuse shall be referred to a treatment program determined to meet their rehabilitation needs, and shall be required to participate in the treatment program upon referral, provided the program services are actually available at the time of referral and are at no charge to the individual.
(d) Violations. It shall be a violation of this Section 20.7-26.5 for a Recipient to fail to comply with the screening, evaluation, and/or treatment requirements set forth in subsections (a), (b), and (c) without good cause. Recipients whose aid is discontinued for violation of this Section 20.7-26.5 shall continue to receive housing assistance for 30 days from the effective date of the notice of discontinuance. For purposes of this subsection (d), “housing assistance” means eligible, verified rent expenses and guaranteed access to in-kind shelter and meal services. The Department may extend an individual’s eligibility for housing assistance beyond 30 days provided the Department finds that such extension is necessary to prevent eviction.
(e) Rules and Regulations. Pursuant to Section 20.7-5, the Executive Director may establish rules and regulations to administer and enforce this Section 20.7-26.5, including but not limited to rules and regulations to:
(1) establish categorical exemptions from screening, evaluation, and treatment requirements relating to illegal drug use where necessary or appropriate to prioritize the allocation of scarce treatment resources and/or ensure that Recipients are not required to participate in multiple activities at the same time; and
(2) establish standards governing determinations relating to a Recipient’s need for an extension of housing assistance beyond 30 days to prevent eviction.
(f) Amendments by the Board of Supervisors. This Section 20.7-26.5 may be amended by the Board of Supervisors by a supermajority vote of eight or more members.
Section 3. Article XIII of Chapter 10 of the Administrative Code is hereby amended by adding Section 10.100-45.5, to read as follows:
SEC. 10.100-45.5. CAAP TREATMENT FUND.
(a) Establishment and Use of Fund. The CAAP Treatment Fund is established as a category two fund to support the costs of the substance abuse screening, evaluation, and treatment program set forth in Section 20.7-26.5 of Article VII of Chapter 20 of the Administrative Code.
(b) Source of Fund. Savings that result from recipient noncompliance with the requirements of Section 20.7-26.5 (Substance Abuse Screening, Evaluation, and Treatment) shall be allocated to the CAAP Treatment Fund.
(c) Administration of Fund. The method for administering the fund and for making deposits thereto and expenditures therefrom shall be approved by the Executive Director of the Human Services Agency, or the Executive Director’s designee.
Section 4. Undertaking for the General Welfare.
In enacting and implementing this ordinance, the City is assuming an undertaking only to promote the general welfare. It is not assuming, nor is it imposing on its officers and employees, an obligation for breach of which it is liable in money damages to any person who claims that such breach proximately caused injury.
Section 5. Severability.
If any provision of this ordinance or any application thereof to any person or circumstance is held invalid, such invalidity shall not affect any provision or application of this ordinance that can be given effect without the invalid provision or application. To this end, the provisions of this ordinance are severable.
Section 6. Conflicts with Other Measures.
This ordinance is intended to establish requirements related to the screening for and treatment of substance abuse by County Adult Assistance Program recipients, and to address the programmatic consequences of noncompliance with those requirements. The ordinance shall be deemed to conflict with any other measure appearing on the same ballot if such other measure addresses the screening for and treatment of substance abuse by County Adult Assistance Program recipients, and the programmatic consequences of noncompliance with those requirements. In the event this ordinance and any other measure as described above appearing on the same ballot are approved by the voters at the same election, and this ordinance receives a greater number of affirmative votes than the conflicting measure, this ordinance shall control in its entirety and the other measure shall be rendered void and without any legal effect. If this ordinance is approved by a majority of the voters but does not receive a greater number of affirmative votes than any other conflicting measure, this ordinance shall take effect to the extent permitted by law.
Section 7. Effective and Operative Dates.
(a) The effective date of this ordinance shall be ten days after the date the official vote count is declared by the Board of Supervisors.
(b) This ordinance shall become operative on January 1, 2025.
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